HomeMy WebLinkAboutSWG2020-000192 - SWG As-Built - 3/21/2025 rppli�nt
ty OSS Installation Report pg. 1
MASON COUNTY PUBLIC HEALTH
APPLICANTI PERMIT INFORMATION
ber SVVG 2020-OOC I I '!, Parcel p 22233-51-00025
ame SAGER C/O S-LINE CONST Subdivision (Name/DIV1BloCk/LOl)
ddress 2971 E PHILLIPS LK LP RD
Zip SHELTON. WA. 9C584InstallerName B-LINE CONSTs 4590 E MASON LAKE OR w DeSlgner Name TOBY TAHJA-SRYETT
.jJSTALLATION CHECKLIST
❑ Pdii$Vslbm Installa'Mn ®Tana(s;Only ❑ Dra.nheid only ❑ Repair ❑OI^e"
System Type
PRESSURE Pretreatment Type NIA
.5 If from foundano0 - - - - - • - _ 1 E] NU ® YES ❑ NO
>50h from wells? - - � -'vL -004 - -- --- . _ . - . ❑ ❑ e
to >50n from surface wal.0 --- -- --- -- ❑ ❑
2 G ❑ ❑
eanout between braiding and tank? • - -- - --- —- _-_ ___ -.
kQ- ® ❑
U Tank battles preseni7 — _ _ _ _ _ _ _ __ _ _ _ _ __ _---- ❑ ❑
24- access risers over each compaMMM?-- - ❑ ® ❑
NEffluent filter installed?- - - - - - - - -- - - - - - - ' - - - - - - ❑
Septic tank size 1200 at Manufacturer SOUND PLACEMENT
0 D box water level and speed ievakerm P9ed? - - - - - - - - - - - - - - - ❑ NIA ❑YES ❑ NO
0O Mamfoid/D-boz accessible from surf8ge7� - - - - - - - - - _ . ❑ ❑ Cl
0< Check valves lnstalled7 .- - - -- -- --- - - - - - - ❑ ❑ ❑
f Transport. Line Size Sc�he/dula/Class
Bedrooms installed (check one) ❑ 2 ❑3 1d14 ❑ 5 ❑6 ❑Corr merOaLiOlher
❑ NIA ❑ YES ❑ No
>100 ft from wells?— - - - - - - - --- - - -- - - - - --- - ❑ Cl El
❑ El ❑
W >100 It from surface water? . - - - -- - - - - -- - -- - -- ---
__. El ❑
Li >101t from potable water hn"?- - -- - - - - ------— _ _ - ❑
ZZ > 5 ft from pioparty lines and easements?— - - - -• ❑ ❑ ❑
K ❑
> 30 tt from downgradw_nt cunamtlqufWabon drains?•- -- ----• ❑ � ❑
Dramfield level and observation ports present - - - -- - - - -- --- ❑
❑ G(aveiess ,ammm or ❑ Clean gravel used? (Ct1e0 One) El
Proper Cover in5idlietl over Uramfield?- - - - - - - ------ --- - -- ❑
Pump tank setbacks consistanl with gephc lank? - - - - - - - -- - - ❑ N/A ® rnS El No
Y. Pump tank size 1500 at Manufacturer SOUND PLACEMENT
Z 24 access nsegsl and accessible from sudace7 - - - - - - - - - - - ❑ a ❑
;5 ❑ ❑
0. Alarm or Control panel Inslalleb? - - - - - - - - - - - - - - - - - - - - ® ❑
2 control Panel equipped with Timer i ETM i Counter - - - - - - - - - - ❑
a_
Pump installed In ❑ Bucket or ❑ On Bock or ® Other PUMP VAULT
tl Pump Makeyf.Aodel ORENCOPF20ti511 ® Floats or El Transducer
Tank draw down 0.411 inlm n Pum t p capacity Z torn Sgmn Height
a �h
Pump on time (v:.n`` PumP off time 3� \ Dail "}y now set at k 9pd
Any Pd,.Aek J .\\ bC SB MQ ai
C Ov P\t4At�
Mason County OS5 Installation Report pg. 2
Parcel* uZ33 - Oclo1S
ABANDONMENT RE CORD
YES
■ No
`.Vera tE°:•ry aosndcned es oan c! !re{ .
If YeY i4llw dWrUe , - . . _ _ _ YES ❑ NO
We!a ail CCJnhp^.e•t{._r•.nec W'.an0 CrWeny a,arda+ed oar WAC2t&:"/2A-0300
RECORD DRAWING
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Record Dtavnng Attached
CERTIFICATION OF INSTALLATION
rIN5TALLER DESIGNER(ENGINEER
I ostaitad mo system in accordance with I Certl/y(1i61 lfle Syalem flag Wenrnstailed 1n dCCnr-
ign vrampadAPPROVED_by Nation dance wish the sePnc design stomped 'APP40VED bylrn Hea/fn artu:het any tlBmat!orts snmm: Mason County Rrbllr.lf9attn and Chet any devienonseen cfaamWNPPmvgd by Ddh rha desrgWr s7lnwn here nave Wen csaa/adappmve(f by vurnCuunry PubaC R9alID and meet off Stale rnySet!and Meson County PuhJK Health entl meat all
and Meson Cpurrry Codes. State line Mason Counly,Cotlev
1/urt eertHY role of In/omra6m eontsw&,l on the i ludhar Caddy feet ,t,nj0mlall�li contained on 01,S
form lid atteched Record Dram g ra accurate
loan olio attached Roca*Drawrn9 isaccurem.
Srpn a rnraw �I oo!a
\..4 ,A erg (i ~ 't
Pointed Name of,
MASON COUNTY PUBLIC HEALTH rr"
The unasrsrgnad approves tree Inyadalbn Report nrrd
Rec^✓d Dmwmg on behalf of Mason County Pubic /y7'' I•,.. . � ,.;:• '
NaaN,h
✓pna6•re of envrranm m�t+earr, Spaueufl Gem tatomp. signature and data)
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